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Staging and Grading
ОглавлениеSTS are histologically distinguished as low (grade I), intermediate (grade II), and high (grade III) grades, based on the degree of tissue differentiation, cellular pleomorphism, cellularity and matrix formation, mitotic index, and the amount of tumor necrosis (Kuntz et al. 1997). Tumor grade is predictive for distant metastasis, local recurrence, and shorter disease‐free intervals. Staging of STS follows a specific TNM staging scheme (Table 4.4) (Dennis et al. 2011; Greene 2002; Kotilingam et al. 2006; MacEwan et al. 2001). Despite the low incidence of lymph node involvement, investigation of draining lymph nodes is advised, including biopsy of suspect lymph nodes (Kuntz et al. 1997; Dennis et al. 2011).
Table 4.4 TNM staging and grading system for soft tissue sarcomas.
Source: Kotilingam et al. 2006; MacEwan et al. 2001; Greene 2002. The American Joint Committee on Cancer.
| T | Primary tumor | |||
| TX | Primary tumor cannot be assessed | |||
| T0 | No evidence of primary tumor | |||
| T1 | Tumor < 5 cm in greatest dimension | |||
| T1a | Superficial tumor | |||
| T1b | Deep tumor | |||
| T2 | Tumor > 5 cm in greatest dimension | |||
| T2a | Superficial tumor | |||
| T2b | Deep tumor | |||
| N | Regional lymph nodes | |||
| NX | Regional lymph nodes cannot be assessed | |||
| N0 | No regional lymph node metastasis | |||
| N1 | Regional lymph node metastasis | |||
| M | Distant metastasis | |||
| MX | Distant metastasis cannot be assessed | |||
| M0 | No distant metastasis | |||
| M1 | Distant metastasis | |||
| G | Histologic grade | |||
| GX | Grade cannot be assessed | |||
| G1 | Low (grade I) | |||
| G2 | Intermediate (grade II) | |||
| G3 | High (grade III) | |||
| Stage | ||||
| I | G1–2 | Any T | N0 | M0 |
| II | G3 | T1a‐b, T2a | N0 | M0 |
| III | G3 | T2b | N0 | M0 |
| IV | Any G | Any T | N1 | Any M |
| Any G | Any T | Any N | Any M |
Serum VEGF and neutrophil counts are positively correlated, and negative between VEGF and hemoglobin content in dogs with sarcoma (De Quieroz et al. 2013).
In contrary to primary care practices with predominating low‐grade STS (51–84%) (McSporran 2009; Bray et al. 2014), studies from referral practices report high‐grade STS are more common (22.7–29%) (Kuntz et al. 1997; Heller et al. 2005).
